The escalating outbreak of disease and displacement of tens of thousands by recent fighting has inflamed one of the world’s worst humanitarian crises, pushing Yemen’s war-pummelled society ever nearer to collapse.

Cholera - a diarrhoeal disease spread by food or water tainted with human faeces - has killed 180 people in less than three weeks, according to the Geneva-based International Committee of the Red Cross (ICRC).

Samira Ali, a worried mother, expressed shock at the scene at Sabaeen Hospital in Sanaa, the ancient capital in the north held by the armed Houthi movement since late 2015.

“My young son suddenly started suffering from severe diarrhoea. We went to the hospital and found it full, we couldn’t find a place,” said Ali, a teacher.

“Only with difficulty were the doctors able to give him the medicines which saved his life. This situation is tragic.”

The United Nations now estimates that in Yemen a child under the age of five dies every 10 minutes from preventable causes, two million people have fled fighting near their homes and only half of hospitals have staff and supplies to function normally.

Already one of the poorest countries in the Middle East, Yemen was engulfed in 2015 by civil war pitting the Houthis against the internationally recognised government of President Abd-Rabbu Mansour Hadi.

A coalition led by Saudi Arabia and backed by the United States intervened on Hadi’s side and has carried out thousands of air strikes targeting the Houthis, though U.N. officials said last year these had killed more than 2,000 civilians as well.

The alliance believes the Houthis, who hold most of Yemen’s main population centres, are a proxy for their arch-foe Iran. The Houthis deny this and say they are defending Yemen from domineering neighbours and U.S. hegemony.

The war has been largely stalemated for 18 months since the coalition retook swathes of the south and east. Over 10,000 people in all have died, but the last serious peace talks lapsed almost a year ago.

As U.S. President Donald Trump makes his first visit abroad with a stop in Riyadh this week, advancing the shared U.S.-Saudi struggle with Iran may prove the priority despite the humanitarian disaster next door.

HANGING BY A THREAD

More than ever before in the war, state institutions are losing their ability to withstand the spread of pestilence and the mounting death toll.

A battle for control of the central bank has left salaries in Houthi-held lands in and around Sanaa largely unpaid for six months, ruining the lives of hospital and sanitation workers.

Children displaced by the war in northwestern Yemen, pose for a photo near their makeshift huts on the pavement of a street in the Red Sea port city of Hodeidah, Yemen. REUTERS/Abduljabbar Zeyad

Pumps to sanitise the water supply sit idle for lack of fuel, while maintenance agencies tasked with chlorinating aquifers go without salaries and supplies.

Doctors treating the cholera outbreak fare little better.

“The health system has been hanging by a thread,” UNICEF’s spokesman in Yemen, Rajat Madhok, said.

“Wages haven’t come in, humanitarian workers and doctors are trying their best but some leave their work to seek jobs where they can get paid. Declining value of the currency hurts and all this has a cascading effect that is badly hurting the sector.”

A streak of misery runs the length of Yemen’s western Red Sea coast - from fighting in the north along the border with Saudi Arabia to a new coalition-backed offensive working its way up to the main port of Hodeidah from the south.

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The campaign has forced around 50,000 to flee for safety from the area this year, according to the United Nations, many of whom had already escaped homes affected by fighting there.

Clutching her young son on Hodeidah’s streets, 19-year-old Saleha Ahmed Ali recounted her weary trek down the coast from the northwest. “We’re from Haradh, but because of the war we fled to Bajel to be safe there. But when the air strikes got worse in Bajel, we fled to Hodeidah,” she said.

“There’s no food or milk for our children. We can’t even find a mat to sleep on or a bucket to wash our children. They haven’t given us tents and it rained yesterday. We don’t know where to hide. We’ve lost our homes. This war has dragged us from place to place.”

Speaking to Reuters by phone from Sanaa, Shabia Mantoo of the U.N. refugee agency UNHCR wondered why the scale of the suffering had not spurred more peacemaking efforts.

“It was already catastrophic, how much worse can it get? Nineteen million people are going through real suffering. Yemen now is an inventory of misery - what more will it take to get the world’s attention?”

HAWKISH ON IRAN

Diplomats and aid workers fear that if Hodeidah turns into a war zone, up to half a million people could be uprooted, stretching already strained aid groups to breaking point.

But resolving Yemen’s burning humanitarian crisis may take a back seat to scoring a blow in the regional rivalries with Iran.

U.S. Defence Secretary Jim Mattis said last month that U.N.-backed talks are needed to resolve the conflict. But the Trump administration is considering an increase in intelligence cooperation with the Saudi-led coalition and has not ruled out U.S. assistance for an assault on Hodeidah.

“The Americans are now much more hawkish on Iran,” a Western diplomat told Reuters. “It’s possible that they could support an escalation of the conflict in Yemen in order to send Iran a message.”

Additional reporting by Abduljabbar Zeyad in Hodeidah; editing by William Maclean and Mark Heinrich